Introduction: Intrusive symptoms are associated with Posttraumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), obsessiveness and suicidal and violent tendencies. They may be the sudden presence of images, thoughts or emotions, sensory perceptions and/or re-experiencing of prior trauma. They may occur spontaneously or be evoked by association. In PTSD the presence of intrusive symptoms result in the defenses of hypervigilance, avoidance and psychic numbing. As a psychiatrist who treats patients with late stage tick-borne diseases (LSTBD), an association is noted between LSTBD and intrusive symptoms. Few articles address this issue (Bär et al., 2005, Fallon et al., 1995 and Stein et al., 1996).

Method: From a database of LSTBD patients representative quotes and cases are presented and 131 cases were reviewed to determine the incidence of intrusive symptoms. These charts were further analyzed for associated symptoms. A literature review was conducted.

Results:Quotes from patients: “Frightening, stabbing, horrific images -usually of death, dying or pain and suffering. Often gory and unreal as in a horror story. Faces mostly with blood or terror exaggerated awful expressions. Visions of stabbing or killing often of those close to you or familiar. Episodic, not continuous. These images don’t seem to necessarily be associated with a particular occasion, place or time, but come and invade the privacy of my mind.” “I had intrusive thoughts of killing women with a knife or an axe, then some mechanism in my head was telling me – “kill her – kill her. “Sometimes I had thoughts of killing my sister’s one year old child or my mother.”

Patient A: 56-year-old female with LSTBD. Episodic symptom flares would occur including headaches, neck and joint pain, vertigo, fatigue and cognitive impairments followed one day later by intrusive symptoms with “disgusting obsessions” and suicidal thoughts. Symptoms improved from treatment with intramuscular penicillin, minocycline, topiramate and olanzapine. Her mother was placed on the Liverpool protocol against consent resulting in death which exacerbated intrusive symptoms.

Patient C: 31-year-old male with a 12 year history of a progressive multisystemic illness including cognitive impairments, sensory hyperacusis, musculoskeletal pain, fatigue, social anxiety, depression, hallucinations, agitation, guilt, crying spells, disability, feeling worthless and suicidal attempts. There were increasing intrusive symptoms related to prior sex abuse. With considerable outpatient and inpatient psychiatric treatment he continued to deteriorate. He recalled a prior tick bite, had a positive Lyme Western blot and was treated with antibiotics which sometimes exacerbated symptoms (Herxheimer reaction). He committed suicide with an Internet suicide kit.

Patient D: 27-year-old male with a history of an abrupt onset of OCD followed by increasing multisystemic symptoms including intrusive aggressive, bizarre sexual and pedophiliac symptoms; depersonalization; cognitive decline; explosive anger and suicidal and homicidal thoughts. He tested positive for Borrelia, Babesia and Bartonella and was treated with psychotropics and antibiotics.

Patient E: 28-year-old male diagnosed with CNS Lyme disease with a reinfection. He had improvement with short courses of antibiotics based on IDSA guidelines but relapsed with increasing cognitive decline, neurological symptoms, intrusive symptoms and impulsivity. He stalked and killed four females.

Conclusion: Intrusive symptoms occur in 34% of LSTBD patients which can contribute to causing OCD, PTSD, obsessiveness, and suicidal and violent tendencies. Trauma from chronic illness and other causes can further exacerbate symptoms. Antibiotics, anti-inflammatory strategies, psychotherapy and psychotropics can reduce symptoms and be lifesaving for some patients.